助人者看不見的傷口：心理助人者替代性創傷形成歷程之初探

Abstract

本研究主要探討參與意外災害救災的心理助人工作者，形成替代性創傷的背景脈絡、替代性創傷形成的歷程，以及替代性創傷內涵，運用現象學取向的質性研究法，透過半結構化深度訪談，了解四位受訪者的替代性創傷經驗，研究結果如下： 壹、 形成替代性創傷的背景脈絡： ㄧ、助人者的內在系統：包含助人者原本的人格特質、對助人工作的態度、諮商風格以及個人過去與死亡、災難相關的生命經驗。 二、助人者的外在系統：包含助人者的社會支持系統，包含家人、朋友、同事主管對助人者救災的態度；以及受災個案所描述表達出的訊息，對助人者的刺激程度。 貳、替代性創傷的形成歷程： 一、助人者同理介入：助人者因為同理災民，深刻感受災民的痛苦，影響情緒認知。 二、心理動力產生變化：情緒受到衝擊並產生反移情，投射對死亡的害怕等心理歷程。 三、機構與災民狀況阻礙助人者救災：機構限制與災民求助動機低使助人者感到受挫。 四、助人者調適受創反應：運用專業學習、紓壓或信念轉變等多種方式調適受創壓力。 參、替代性創傷的內涵： ㄧ、身心煎熬：助人者承受和倖存者類似的次級創傷壓力反應。 二、認知基模改變並影響行為表現：助人者在「安全感」和「控制」等認知基模改變較多，「親密」、「信任」的認知基模改變較少，但沒有發現「尊重」認知基模的改變。 三、助人者的價值信念改變：助人者在世界觀、自我和專業認同及靈性層面的參考架構改變，且影響專業界限。

This project is aimed to discuss disaster counselors, background of vicarious trauma, content that cover substitute trauma, and formation of substitute trauma. By using phenomenological approach and methodology, we interviewed four victims and had a thorough understanding in experiences regarding vicarious trauma. We thereby propose our suggestion of trauma salvaging jobs and provide solid research data for future references. Here we list our research outcome: A. Factors formulating substitute trauma background 1. The internal system of the helper: including integrity characteristics of the helper, attitude toward work, style of consultation, and personal experiences with death or disaster . 2. The external system of the helper: including support system such as family members, friends, associates and supervisor; the attitude toward disaster relief ,case report reflective of message from the victim, and level of stimulation of the helpers. B. Process of vicarious trauma: 1. Empathy of the helpers: for counselors empathy victims , they feeling the painful deeply , than effect counselor’s emotion and cognition 2. Change of psychodynamic: they feel shock , had countertransference, and some psychodynamic processes like fearing to the death. 3. Impediment associated with organization and villagers that influence relief workers: the organization limitation and victim`s low motivation let counselors feeling sadly. 4. Plus accommodation of trauma reaction of helpers: learn professional knowledge , relax and change beliefs to accommodation trauma stress. C. Content covering vicarious trauma 1. Sufferings: secondary trauma stress symptoms of helpers and escapers. 2. Change of cognitive schemas and impact on behavior change: the helpers make huge changes in” sense of security” and “power of control” of cognitive schemas; in contrast, fewer in intimacy and trust. To the least stand, respect in this model is not observable. 3. Belief change of the helpers: changes in viewpoints of the world, ego, profession identity, level of spiritual in terms of frame of reference, and influence toward professional boundary.